Literature review on child abuse
Abuse: review of the do barcellos o antônio de pretti espindula de oliveira lima vicente andreoli4. Universidade federal de são paulo, sports traumatology center, são paulo, sp, -accidental injuries in children are an important cause of morbidity and mortality in this population. The fracture of the femur is associated in more than 60% of child abuse in children younger than 3 years. The objective was to review the literature on child abuse in the major databases and report a rare case of bilateral subtrochanteric femur fractures associated with unilaterall humeral fracture in a 28-day newborn. The orthopedic surgeon is often the first physician to evaluate these children, so a high degree of suspicion, and a physical examination and a detailed clinical history is mandatory when evaluating a newborn with musculoskeletal words: femoral fractures; humeral fracture; child r raising of awareness of child abuse has contributed towards better understanding of this complex problem. It has been estimated that the annual incidence of abuse is between 15 and 40 cases per 1,000 children.
Thus, approximately one million children become victims every year and more than 1,200 die as a result of e the severity of the problem, it is highly prevalent. 3 concluded that abuse was more common among children under the age of three years, and that multiple fractures were also more common among children who suffered brazil, no data on the incidence of child abuse has been established. 4 recent studies show that among every 1,000 children, ten are victims of abuse and that of these, 2% to 3% die. The literature on abuse among newborns is sparse and there are few studies on children under the age of one res are the second commonest presentation of this condition and orthopedists are often the first physician to evaluate these children. The objectives of this study were to conduct a review of the literature on this topic and report on a case, never previously reported in the literature, of a 27-day-old newborn who was a victim of abuse, with bilateral subtrochanteric femoral fractures and a unilateral humeral fracture, and to conduct a review of the literature on this investigation was conducted in the main databases (lilacs, pubmed and embase) using the following descriptors: non-accidental injury, child abuse, child neglect, femoral fractures and humeral inclusion criteria were that the article needed to have been published within the last 12 years, in the portuguese, english or spanish languages, or that they were regarded as classic studies on the topic. At this time during the consultation, the mother denied that the child had suffered any traumatic event, alleging that she had been close to the child at all times.
The hospital's social assistance team was put into action and, concomitantly, the guardianship the fourth day of hospitalization, the orthopedic team was asked to provide an interdisciplinary consultation regarding the child's case, because of bilateral edema on the thighs and because the child was crying a lot if its legs were detailed orthopedic examination, with imaging examinations, it was determined that the child presented bilateral subtrochanteric femoral fractures associated with a unilateral humeral fracture in the left arm (figs. On this day, the mother reported that the child had fallen to the floor in the bathroom and its legs had hit the edge of the bath, thus contradicting her story at the time of hospital admission. Small plaster-cast splint was immediately applied to the left arm, extending from the axilla to the palm, and bilateral skin traction was applied to the legs, since the pediatric team asked for any procedure under anesthesia at that moment to be postponed until the child's infectious and respiratory conditions had this period, serum samples were collected for tests and metabolic and congenital diseases were investigated. All pathological conditions that form differential diagnoses with child abuse, such as osteogenesis imperfecta, were ruled the seventh day of hospital stay, the child was subjected to bilateral plaster-cast immobilization from the chest to the malleolus, under sedation and analgesia, in the surgical child was kept immobilized in the plaster cast for three weeks. 4 radiograph of the femurs at the age of three child remained hospitalized for a further week, because of the social problems and then, after release, was taken to a shelter institution for children abandoned by their child was brought to the outpatient clinic in the second, fourth and sixth months (figs. 5, 6, 7 and 8), for follow-up consultations, through which it could be seen that the child was completely healthy, without anisomelia and/or associated deformities (fig.
9 photograph at the age of six months, showing absence of anisomelia or significant tly, the legal procedures for guardianship of the child are underway and a court hearing to decide on guardianship is 1946, caffey6,7 described an association between subdural hematomas and fractures of long bones in infants. In 1961, the american academy of pediatrics established the expression "battered child", defined as a child who had suffered non-accidental injuries as a result of attitudes or omissions by its parents or other adults responsible for the child. Legally, children are considered to be individuals up to but not completing 12 years of age and adolescents are considered to be between 12 and 18 years of abuse can be defined as any action or omission by the adult caregiver or older adolescent that might result in damage to the child's physical, emotional, intellectual, moral or social development of the child or adolescent. In 2001, the brazilian ministry of health determined that notification of any form of violence against children and adolescents would be mandatory for all healthcare professionals, and that failure to do so would render the healthcare professional liable to a fine of three to twenty reference salaries, with doubling of the fine in the event of recurrence. The pattern of non-accidental injuries consists mainly of metaphyseal lesions, multiple fractures at different stages of consolidation, fractures of posterior ribs and fractures of long bones in children under the age of two res of the long bones in very young children may represent one of the main pieces of evidence of physical abuse. Femoral fractures are associated with abuse syndrome in 60% of the cases affected children under the age of three years11 and up to 85% among children under the age of one year.
Studied 35 cases of children under the age of three years who had suffered diaphyseal fractures of the femur. In 50% of the children reassessed, there were indications of physical abuse and negligence, such as triggering of femoral fractures. Anderson reported rates of suspected abuse of 79% and 83% among children under the ages of two years and 13 months, respectively, when femoral fractures were present. Signs suggestive of child abuse include the presence of multiple acute lesions (ecchymosis, hematoma, excoriation, bites, burns and edema of soft tissues), previous history of abuse, subdural hematoma, behavioral alterations, presence of multiple fractures (especially in the femur, tibia and humerus) and/or fractures at various stages of healing. In the case reported here, the newborn presented multiple fractures, but all of them were in the acute phase and there were no skin lesions or subdural ing to pfeiffer, a clinical history or physical examination demonstrating signs of frequent lesions that are said to be accidental and an unexplainable delay between the "accident" and seeking medical care are general signs suggestive of physical abuse. In our case, the mother only sought medical care because of the condition of respiratory insufficiency and fever that the child presented, which led us to believe that the trauma had occurred some days before the time of hospital et al.
Showed that orthopedists are the main investigators (in absolute numbers) of physical abuse among children with femoral fractures, followed by pediatricians. They came to the conclusion that patients under the age of 18 months who presented fractures of the ribs, tibia, humerus or femur were more likely to have suffered abuse, while those over the age of 18 months with fractures of the long bones (femur and humerus) presented greater likelihood of having suffered accidental trauma. Reported that black children had higher rates of non-accidental lesions than did white children of the same age group, but also reported that those children were more likely to the evaluated and registered due to suspicion of abuse, thus showing that ethnic difference exist in assessment and communication of pediatric fractures due to child abuse. In the case presented here, the mother and the newborn were not a systematic review on 32 studies, kemp et al. Concluded that fractures resulting from abuse were more common among children under the age of three years, and that multiple fractures were also more common in the group of children who had suffered abuse. They came to the conclusion that during evaluations on individual fractures, the site, the type of fracture and the child's developmental stage could help in diagnosing et al.
They stated that these fractures account for 46% of the fractures of the proximal femur, but that they account for only 1% of the fractures in children. Reported on two cases of growth plate lesions in the proximal femur, in children who had been victims of abuse, and they drew attention to the need to think of the possibility that these lesions could be a consequence of abuse, despite the diagnostic difficulties, given that the center of ossification of the femoral head appears at the age of four months. Thus, this type of fracture in this age group should signal that this lesion is not accidental, as in our diagnosing battered child syndrome, physicians need to be cautious and make differential diagnoses, particularly with the following pathological conditions: osteogenesis imperfecta, congenital insensitivity to pain, scurvy, congenital syphilis, caffey's disease, multiple fractures of severe rickets, hypophosphatemia, leukemia, metatarsal neuroblastoma, sequelae of osteomyelitis and septic arthritis. Demonstrated that children who were victims of abuse presented worse cognitive function and deficits in motor skills, expression and language reception during their growth. Healthcare professionals therefore have a social commitment towards detecting and notifying suspected cases of child abuse, and should be prepared to identify it. In the present case, the mother was within the period of occurrence of puerperal psychosis; the child was her first and the father was not present.
The mother was sent to the hospital's psychiatry department for investigation and possible is known that approximately 50% of the children who are victims of physical abuse who return home are subsequently beaten again. Therefore, there needs to be a high degree of suspicion in attending children with fractures or skin lesions that are poorly explained by the trauma mechanism, like in the present case report, given than there is no pathognomonic fracture in child abuse cases. Physicians who suspect that a case is one of child abuse should immediately communicate this to one of the following three bodies: the guardianship council, a police station or the public attorney's office. All of these institutions have the duty to safeguard and defend the rights of children and abuse should always be borne in mind as a differential diagnosis among children who present fractures that are poorly explained by trauma mechanisms, particularly femoral fractures in children who cannot yet walk. These cases need to be managed by a multidisciplinary team because of the high risk of recurrence of possible death among these children. São paulo: saraiva; er 03, 2011; accepted:Conflicts of authors declare that there was no conflict of interests in conducting this performed in the department of orthopedics and traumatology, universidade federal de são paulo (dot-unifesp/epm), são paulo, sp, is an open access article distributed under the terms of the creative commons attribution non-commercial license, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly nd state university tations and tations and a theory of child abuse: a review of the f.
Ix, 168 leaves 28 psychology, child tly, there exists no conclusive etiology of child abuse although there are two major and contrasting theories which attempt to impart a systematic interpretation to the data. The purpose of this study was to determine what are the significant factors in child abuse and to what extent the respective theories render a coherent and comprehensive explanation of these factors. This study aggregated the data on the demographic, social, economic, and psychological features of the child abuse victim and perpetrator. Each study was analyzed according to a methodology of review which considered the problems involved in eliciting meaningful data from a group of studies grounded on different assumptions and conducted according to disparate research designs. The studies were compared and contrasted to determine what factors were significantly related to child abuse. Thereafter, both major theories of child abuse were tested against the findings of the literature review to determine to what extent the respective theories successfully predicted and related significant factors in child abuse.
The review of the literature clearly established a demographic profile of the child abuse victim and his family. Abusing families tend to have more than the average number of children, but usually select only one child - frequently, the eldest or the youngest - as the target for abuse. The child is likely to have been born prematurely and to have had more than the usual number of serious physical illnesses or disabilities throughout his life. In addition, a significant number of abused children display intellectual, social, and psychological dysfunction which may have resulted from injuries sustained from previous abuse. Most injuries stemming from child abuse fall into the general category of superficial bruises and welts although compared with accidental childhood injuries, there is a higher frequency of fractures and head injuries. The pattern that emerges from the somewhat limited data is that abused children are unusually impaired in intellectual, social, and psychological functioning.
Nearly all child abuse is committed by parental figures most of whom are the natural mothers and fathers of abused children. Most abusing parents are around twenty-five years old reflecting the fact that the majority of abuse victims are infants and younger children. Although only one parent actually attacks the abuse victim, generally speaking, the other parent is overtly, or at least covertly involved in abusing the child. A general atmosphere of instability and disruption surrounds the child abusing family indicated by frequent discord among married parents, as well as separations and divorces. On all measures of socioeconomic status, child abusing families have low achievement and face the stresses of poverty and its associated conditions. Neither a sociocultural or a psychodynamic theory of child abuse effectively relates and explains all the significant findings of the literature review.
While the former predicts the several environmental factors significantly related to child abuse and the latter explains the significant findings associated with the perpetrator, neither theory provides an explanation of the role of the child abuse victim. This review suggests that an alternative theoretical framework which incorporates environmental factors and relates significant factors about the child abuse victim and perpetrator will produce the most comprehensive explanation of child nd state university. Of tent context to search:Across all me via email or y expert sion ibility nd state university tations and tations and a theory of child abuse: a review of the f.